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Graft, Vol. 6, No. 2, 120-128 (2003)
DOI: 10.1177/1522162803256719
© 2003 SAGE Publications

Graft Dysfunction

Geoffrey H. Haydon, MRCP, MD

Liver Unit Queen Elizabeth Hospital, geoffhay{at}

The causes of graft dysfunction are classified either according to the time posttransplantation or to the etiology of graft dysfunction. Primary dysfunction can be due to massive hemorrhagic necrosis, ischemia/reperfusion injury, or hepatic artery thrombosis. Acute cellular rejection (ACR) occurs in 20% to 80% of grafts, usually 5 to 30 days posttransplant. ACR generally is asymptomatic. Chronic ductopenic rejection is defined histopathologically by obliterative vasculopathy and bile duct loss. CMV and EBV infections also diminish graft function. Malignancies occur in solid organ transplant recipients with a frequency 10-1000 times that of the normal population. Skin cancer and lymphoma are the most common types. Posttransplant lymphoproliferative disorders (PTLD) are associated with EBV infection. There are three types of PTLD: polyclonal B-cell hyperplasia, polymorphic B-cell lymphoma, and monoclonal polymorphic B-cell lymphoma. Graft ischemia is due to hepatic artery thrombosis (HAT), hepatic artery stenosis, and portal vein thrombosis. Biliary complications are the most frequent late complications of liver transplantation, with an incidence of 15% to 20%.

Key Words: liver transplantation • Banff criteria • cytomegalovirus • Epstein-Barr virus

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